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NICE committee, chaired by CAPC's Prof Alastair Hay publishes guidance on antimicrobial resistance

24 February 2015

NICE has proposed measures for health and social care providers to help tackle the growing threat of antimicrobial resistance. The aim is to ensure that antibiotics continue to be effective in treating infections.

NICE’s draft medicines practice guideline on antimicrobial stewardship is intended to help health and social care commissioners, providers and prescribers promote and monitor the sensible use of antimicrobials to preserve their future effectiveness.

Antimicrobial medicines such as antibiotics have been the mainstay of treating infections for over 60 years. Although a new infectious disease has been discovered nearly every year over the past 30 years [1], very few new antibiotics have been developed. This means existing antibiotics are used to treat an ever greater variety of infections and infectious diseases.

NHS Prescription services annual National Antibiotic Charts show that overall antibiotic prescribing in the community in England has been steadily increasing over several years.

“The more we use antibiotics, the less effective they become as diseases evolve and become resistant to existing antimicrobial medicines” said Professor Alastair Hay, Professor of Primary Care and chair of the committee which developed the guideline. “Resistance to all antimicrobials is increasing and, combined with a lack of new antimicrobial medicines, there is a heightened risk in the future that we may not be able to treat infections effectively.

“NICE’s recent guidance on diagnosing and treating pneumonia takes as its starting point the need for accurate assessment of respiratory infections like pneumonia to allow healthcare professionals to prescribe antibiotics responsibly. This adds to a number of initiatives to tackle the growing concerns about antimicrobial resistance and the appropriate use of antimicrobials, all within the context of overall antibiotic prescribing that has increased in primary care in England year on year.

“This NICE guideline considers the whole area of antimicrobial prescribing. It looks at the evidence and makes recommendations for health and social care practitioners and organisations on the best ways to minimise antimicrobial resistance.”

As well as highlighting the need for local antimicrobial stewardship programmes, the draft guideline also recommends setting up multidisciplinary antimicrobial stewardship teams working across all care settings. These teams should be able to review prescribing and resistance data frequently and feed this information back to prescribers. They should also be able to work with prescribers to understand the reasons for very high, increasing or very low volumes of antimicrobial prescribing as well as provide feedback and assistance to prescribers who prescribe antimicrobials outside of local guidelines where this is not justified.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “This draft guidance recognises that we need to encourage an open and transparent culture that allows health professionals to question antimicrobial prescribing practices of colleagues when these are not in line with local and national guidelines and no reason is documented.”

“But it’s not just prescribers who should be questioned about their attitudes and beliefs about antibiotics”, continued Professor Baker. “It’s often patients themselves who, because they don’t understand that their condition will clear up by itself, or that perhaps antibiotics aren’t effective in treating it, may put pressure on their doctor to prescribe an antibiotic. Nationally, 41.6 million antibacterial prescriptions were issued in 2013 -14 at a cost to the NHS of £192 million [2]. Despite considerable guidance that prescribing rates of antibiotics should be reduced, 9 out of 10 GPs feel pressured to prescribe antibiotics [3], and 97 percent of patients who ask for antibiotics are prescribed them.”[4]

“The draft guideline therefore recommends that prescribers take time to discuss with patients the likely nature of their condition, the benefits and harms of immediate antimicrobial prescribing, alternative options such as watchful waiting and/or delayed prescribing and why prescribing an antimicrobial may not be the best option for them – for example, if they have a self-limiting respiratory tract infection. The draft guideline also recommends that patients are given advice about who they should contact if they have concerns about infection after discharge from hospital.”

Source: NICE


  1. Annual report of the Chief Medical Officer 2011: volume two
  2. HSCIC Prescriptions dispensed in the Community, England 2003-2013.
  3. NESTA poll, August 2014 ‘Benefit of the doubt’ is the basis for prescribing antibiotics, finds Longitude survey.
  4. General Practitioner, July 2013 Educational Talks, ‘slash GP antibiotic prescribing’.

About the draft guidance

  1. The draft guideline on antimicrobial stewardship is available on the NICE website at /guidance/indevelopment/gid-antimicrobialstewardship/documents from Wednesday 18 February. 
  2. This is the first NICE guidance to deal exclusively with the issue of antimicrobial use and the growing problem of antimicrobial resistance. NICE is also developing a public health guideline that will focus on changing people’s knowledge, attitudes and behaviours in relation to the use of antimicrobials. There will also be a quality standard on antibiotic prescribingas part of a suite of new public health quality standards.
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